ASCO: Cancer Highlights
You may be interested in this update on cancer research and progress:
Report Highlights Cancer Advances
By Charles Bankhead, Staff Writer, MedPage Today
Published: November 09, 2009
As the war on cancer enters its fifth decade, 51 studies stood out as examples of progress that occurred in the past year, as determined by the American Society of Clinical Oncology (ASCO) and reported in "Clinical Cancer Advances 2009."
Reflecting input from specialists throughout the field, the ASCO annual report highlights research developments for nine types of cancer, as well as cancer disparities, quality of life and quality of care, and cancer prevention and screening. "As this report demonstrates -- and as history shows -- investment in clinical cancer research pays off," ASCO president Douglas Blayney, MD, of the University of Michigan in Ann Arbor, said in a statement included in the report. "Since 1990, cancer mortality rates have declined by 15%. Today, two-thirds of patients survive at least five years after diagnosis, compared to just half of patients 40 years ago." "Thanks to basic research advances, we are entering an era of personalized cancer medicine, in which treatment is tailored to the unique genetics of the individual," Blayney added.
The entire report appears online in the Journal of Clinical Oncology, but here is a summary of developments related to some of the most common cancers. In an attempt to provide context and a diversity of viewpoints,MedPage Today, in collaboration with ABC News, solicited comments from cancer specialists who were not involved in developing the ASCO publication. As appropriate, their views are included with the review of cancer research highlights.
Results of a large, randomized clinical trial settled a longstanding debate about the superiority of a standard three-drug chemotherapy regimen versus monotherapy with capecitabine (Xeloda) for breast cancer in women 65 and older. Women randomized to the single agent had a twofold increase in the risk of relapse and death compared with women who received cyclophosphamide, methotrexate/fluorouracil, and doxorubicin. Three-year relapse-free survival was 68% with monotherapy and 85% with the combination. Overall survival was 86% with monotherapy versus 91% with the combination.
Stefan Gluck, MD, of the University of Miami, had a different take on the study results. Acknowledging the better survival in the capecitabine arm, Gluck took issue with the trial's clinical significance. "This is not major research. It did not change practice, did not change outcome, did not change toxicity, and did not change cost."
On the other hand, Hyman Muss, MD, of the University of North Carolina in Chapel Hill, cited the trial results as an example of clinical research that has influenced his clinical practice in the past year. Two studies provided evidence that the investigational class of agents known as poly(ADP-ribose) polymerase (PARP) inhibitors has efficacy in so-called triple-negative breast cancer. The agents block cancer cells' ability to repair DNA damage, including damage inflicted by chemotherapy.
Seconding the ASCO specialists' view, Gluck said the investigation of PARP inhibitors is a major< accomplishment in the field of breast cancer. Michael J. Fisch, MD, of the University of Texas M.D. Anderson Cancer Center in Houston, agreed, calling PARP inhibitors "a new category of treatment for a very difficult-to-treat subset" of breast cancer patients.
Cancer Prevention and Screening
Two large randomized clinical trials showed that routine screening for prostate cancer with PSA tests had little or no effect on prostate cancer mortality. ASCO cancer specialists said the message from the trials is that routine PSA testing detects a large number of clinically insignificant cancers and can lead to unnecessary treatment.
The University of North Carolina's Muss said the PSA studies and the trial that evaluated CA125 as a guide to therapy both should have a practice-changing impact on oncology. The ASCO report also reviews the organization's major recommendations for the past year, emphasizing ASCO's support for increased funding for cancer research and removal of regulatory barriers to research, implementation of quality-of-care measures for cancer care, and elimination of barriers to access to high-quality cancer care.
Focusing on policy issues, Roy Jones, MD, of M.D. Anderson, cited a need for insurance coverage that addresses the impact of new technology on the cost of healthcare. He suggested a two-tiered system of coverage comprising a basic insurance plan for "proven cost-effective care" and supplemental policies that "willing purchasers would pay for the privilege of unproven high-tech."
"Since the current healthcare reform proposals fail to address the major cost driver, they are all unlikely to reduce costs," said Jones. "On that pessimistic note, we might be able to consider this or similar plans the 'go round.'"
This article was developed in collaboration with ABC News.
Journal of Clinical Oncology
Petrelli N, Winer EP, eds "Clinical cancer advances 2009. Major research advances in cancer treatment prevention, and sceening"
J Clin Oncol
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